Study:
Paramedics Save More Lives When They Don’t Follow the
Rules
April 10,
2006
From:
Daniel Stolte,
520-626-4083
Survival
rates following the most common form of cardiac arrest increased three-fold when
emergency medical personnel used a new form of CPR developed at The University of Arizona Sarver Heart
Center. The new approach, called Cardiocerebral Resuscitation, is
dramatically different from guideline-directed CPR procedures.
Because of
its importance, the editors of the American
Journal of Medicine chose to publish the report online in advance of
the journal’s April print issue.
“Cardiocerebral
Resuscitation eliminates certain previously recommended procedures and
reprioritizes the order of actions the emergency medical services deliver,” said
Michael J. Kellum, MD, leading
author of the study report.
Under the
new approach, first responders skipped the first steps of the standard protocol:
intubating the patient for ventilation and delivering a shock using a
defibrillator. While still attaching the victim to a defibrillator, they did not
wait for the device to analyze the patient’s heart rhythm, but started fast,
forceful chest compressions.
“Intubating the patient
and waiting for the defibrillator to do its analysis takes time – time a cardiac
arrest victim doesn’t have,” said Gordon A.
Ewy, MD, director of the
“In
laboratory experiments, we found that the most important factor of survival is
to keep the blood moving through the body by continuous chest compressions,”
said Dr. Ewy, who pioneered the CPR Research Group at the
First
responders applying the new protocol were able to resuscitate the majority (58
percent) of out-of-hospital witnessed cardiac arrest victims, provided they had
a “shockable” initial heart rhythm. “Shockable” describes a condition in which
the heart quivers rather than beats but can be shocked back into normal beat
with a defibrillator. In contrast, the survival rate was only 20 percent in the
3 years before, when the standard CPR protocol was used.
The
current study, which involved 125 patients, reports the experiences after the
revised protocol was implemented in two Wisconsin counties in a collaboration
between the CPR Research Group at the
“We think
one of the reasons that CPR as directed by international guidelines has not
worked well is because it is designed for two entirely different conditions:
cardiac arrest and respiratory arrest,” said Dr. Ewy. “What is good for
one may not be good for the other. Cardiocerebral Resuscitation is
designed for cardiac arrest. Sudden unexpected collapse in an adult is
almost always due to cardiac arrest. The new approach is not recommended for
respiratory arrest, a much less common situation following, for example,
drowning or drug overdose.”
As a cause
of death, out-of-hospital cardiac arrest is second only to all cancer deaths
combined, taking the lives of 490,000 Americans every year. Unlike the
impression created by TV shows such as “E.R.”, the chance of surviving an
out-of-hospital cardiac arrest is usually much less than 10 percent. In spite of
periodic updates of standardized international guidelines, survival rates have
remained more or less unchanged over the last couple of decades. Survival rates
are better only if an automated external defibrillator (AED) is available and is
used soon after the cardiac arrest.
Reference:
Michael J. Kellum, MD,
Kevin W. Kennedy, MS, and Gordon A. Ewy, MD. Cardiocerebral
Resuscitation Improves Survival of Patients with Out-of-Hospital
Cardiac Arrest. The American Journal of
Medicine (2006) 119, 335-340.
For
more information and to obtain a copy of the report, please
contact:
Gordon A. Ewy, MD,
Director,
Daniel Stolte, Office
of Communications,
Michael E. Kellum, MD,
Phone 262-949-2270, mkellum@mhsjvl.org
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